Developmental stability of general and specific factors of psychopathology from early childhood to adolescence: dynamic mutualism or p-differentiation?

Higher-order dimensions of psychopathology in a neurodevelopmental transdiagnostic sample

Hierarchical dimensional models of psychopathology derived for adult and child community populations offer more informative and efficient methods for assessing and treating symptoms of mental ill health than traditional diagnostic approaches. It is not yet clear how many dimensions should be included in models for youth with neurodevelopmental conditions. The aim of this study was to delineate the hierarchical dimensional structure of psychopathology in a transdiagnostic sample of children and adolescents with learning-related problems, and to test the concurrent predictive value of the model for clinically, socially, and educationally relevant outcomes. A sample of N = 403 participants from the Centre for Attention Learning and Memory (CALM) cohort were included. Hierarchical factor analysis delineated dimensions of psychopathology from ratings on the Conner's Parent Rating Short Form, the Revised Children's Anxiety and Depression Scale, and the Strengths and Difficulties Questionnaire. A hierarchical structure with a general p factor at the apex, broad internalizing and broad externalizing spectra below, and three more specific factors (specific internalizing, social maladjustment, and neurodevelopmental) emerged. The p factor predicted all concurrently measured social, clinical, and educational outcomes, but the other dimensions provided incremental predictive value. The neurodevelopmental dimension, which captured symptoms of inattention, hyperactivity, and executive function and emerged from the higher-order externalizing factor, was the strongest predictor of learning. This suggests that in struggling learners, cognitive and affective behaviors may interact to influence learning outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

On top or underneath: where does the general factor of psychopathology fit within a dimensional model of psychopathology?

BACKGROUND

Dimensional models of psychopathology are increasingly common and there is evidence for the existence of a general dimension of psychopathology ('p'). The existing literature presents two ways to model p: as a bifactor or as a higher-order dimension. Bifactor models typically fit sample data better than higher-order models, and are often selected as better fitting alternatives but there are reasons to be cautious of such an approach to model selection. In this study the bifactor and higher-order models of p were compared in relation to associations with established risk variables for mental illness.

METHODS

A trauma exposed community sample from the United Kingdom (N = 1051) completed self-report measures of 49 symptoms of psychopathology.

RESULTS

A higher-order model with four first-order dimensions (Fear, Distress, Externalising and Thought Disorder) and a higher-order p dimension provided satisfactory model fit, and a bifactor representation provided superior model fit. Bifactor p and higher-order p were highly correlated (r = 0.97) indicating that both parametrisations produce near equivalent general dimensions of psychopathology. Latent variable models including predictor variables showed that the risk variables explained more variance in higher-order p than bifactor p. The higher-order model produced more interpretable associations for the first-order/specific dimensions compared to the bifactor model.

CONCLUSIONS

The higher-order representation of p, as described in the Hierarchical Taxonomy of Psychopathology, appears to be a more appropriate way to conceptualise the general dimension of psychopathology than the bifactor approach. The research and clinical implications of these discrepant ways of modelling p are discussed.

Is executive dysfunction a risk marker or consequence of psychopathology? A test of executive function as a prospective predictor and outcome of general psychopathology in the adolescent brain cognitive development study®

A general psychopathology ('p') factor captures shared variation across mental disorders. One hypothesis is that poor executive function (EF) contributes to p. Although EF is related to p concurrently, it is unclear whether EF predicts or is a consequence of p. For the first time, we examined prospective relations between EF and p in 9845 preadolescents (aged 9-12) from the Adolescent Brain Cognitive Development Study® longitudinally over two years. We identified higher-order factor models of psychopathology at baseline and one- and two-year follow-up waves. Consistent with previous research, a cross-sectional inverse relationship between EF and p emerged. Using residualized-change models, baseline EF prospectively predicted p factor scores two years later, controlling for prior p, sex, age, race/ethnicity, parental education, and family income. Baseline p factor scores also prospectively predicted change in EF two years later. Tests of specificity revealed that bi-directional prospective relations between EF and p were largely generalizable across externalizing, internalizing, neurodevelopmental, somatization, and detachment symptoms. EF consistently predicted change in externalizing and neurodevelopmental symptoms. These novel results suggest that executive dysfunction is both a risk marker and consequence of general psychopathology. EF may be a promising transdiagnostic intervention target to prevent the onset and maintenance of psychopathology.

Evaluating the criterion validity of hierarchical psychopathology dimensions across models: Familial aggregation and associations with research domain criteria (sub)constructs

The Hierarchical Taxonomy of Psychopathology (HiTOP) posits that psychopathology is a hierarchy of correlated dimensions. Numerous studies have examined the validity of these dimensions using bifactor models, in which each disorder loads onto both a general and specific factor (e.g., internalizing, externalizing). Although bifactor models tend to fit better than alternative models, concerns have been raised about bifactor model selection, factor reliability, and interpretability. Therefore, we compared the reliability and validity of several higher-order HiTOP dimensions between bifactor and correlated factor models using familial aggregation and associations with Research Domain Criteria (RDoC; sub)constructs as validators. Lifetime psychopathology was assessed in a community sample (N = 504) using dimensional disorder severity scales calculated from semistructured interview data. A series of unidimensional, correlated factor, and bifactor models were fit to model several HiTOP dimensions. A bifactor model with two specific factors (internalizing and disinhibited externalizing) and a correlated two-factor model provided the best fit to the data. HiTOP dimensions had adequate reliability in the correlated factor model, but suboptimal reliability in the bifactor model. The disinhibited externalizing dimension was highly correlated across the two models and was familial, yet largely unrelated to RDoC (sub)constructs in both models. The internalizing dimension in the correlated factor model and the general factor in the bifactor model were highly correlated and had similar validity patterns, suggesting the general factor was largely redundant with the internalizing dimension in the correlated factor model. These findings support concerns about the interpretability of psychopathology dimensions in bifactor models. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Multimorbidity networks of mental disorder symptom domains across psychopathology severity levels in community youth

Our aim was to scrutinize multimorbidity in a community sample of youths (Philadelphia Neurodevelopmental Cohort) in form of co-occurrences of DSM-IV disorder symptom domains, elucidating if and when specific symptom domain interrelations emerge as mental disorder severity levels increase. We estimated four multimorbidity networks based on four severity cut-offs ('at least symptomatic', 'at least subthreshold', 'at least threshold', and 'impaired') and compared them pairwise on two measures: global network strength and network structure. We further computed community clusters for each network to detect symptom domain interrelations. Pairwise comparisons of the multimorbidity networks based on data from 9410 probands showed significant differences in global strength of the networks with the two highest severity cut-offs ('impaired' and 'at least threshold') with the at least symptomatic networks (p < .05). The networks with the three highest severity cut-offs ('impaired', 'at least threshold', and 'at least subthreshold') differed significantly (p < .001) from the at least symptomatic network regarding global network structure but did not significantly differ from each other (p > .05). We identified four common clusters in the impaired, at least threshold, and at least subthreshold networks consisting of i) domains associated with behavioral disorders; ii) domains associated with anxiety disorders (agoraphobia, social anxiety and specific phobia); iii) domains associated with anxiety/mood/eating and; iv) domains associated with mood/eating disorders. We found that major mental disorder symptom domain interrelations become consistent from a subthreshold level onwards. Findings suggest that specific multimorbidity patterns emerge as psychopathology severity levels increase.

Elucidating the Links Between Mother and Father Alcohol Use Disorder and Adolescent Externalizing Psychopathology: A Test of Transmission Specificity Within Competing Factor Structures and Genetic and Environmental Liabilities

Parental alcohol use disorder (AUD) is a substantiated risk factor for adolescent externalizing psychopathology; however, the level of specificity at which risk from parental AUD is transmitted to adolescent offspring should be interrogated further. The current study modeled competing factor structures of psychopathology in a sample of 502 adolescent twin pairs (Mage = 13.24 years) and tested associations with mother and father AUD. The bifactor model exhibited the best fit to the data when contrasted with correlated factors and general factor models. Paternal AUD predicted the externalizing and internalizing correlated factors, the adolescent P-factor but not the residual externalizing and internalizing factors, and the general factor. No significant associations with maternal AUD were noted. Lastly, the latent factors of adolescent psychopathology were all moderately heritable (h2 = 0.44-0.59) and influenced by the nonshared environment. Shared genetic factors primarily explained externalizing and internalizing covariance. Findings suggest that efforts to mitigate risk in offspring of fathers exhibiting AUD require broader approaches that address the full range of adolescent symptomology.

The p Factor Consistently Predicts Long-Term Psychiatric and Functional Outcomes in Anxiety-Disordered Youth

OBJECTIVE

Pediatric anxiety disorders can have a chronic course and are considered gateway disorders to adult psychopathology, but no consistent predictors of long-term outcome have been identified. A single latent symptom dimension that reflects features shared by all mental health disorders, the p factor, is thought to reflect mechanisms that cut across mental disorders. Whether p predicts outcome in youth with psychiatric disorders has not been examined. We tested whether the p factor predicted long-term psychiatric and functional outcomes in a large, naturalistically followed-up cohort of anxiety-disordered youth.

METHOD

Children and adolescents enrolled in a randomized controlled treatment trial of pediatric anxiety were followed-up on average 6 years posttreatment and then annually for 4 years. Structural equation modeling was used to estimate p at baseline. Both p and previously established predictors were modeled as predictors of long-term outcome.

RESULTS

Higher levels of p at baseline were related to more mental health disorders, poorer functioning, and greater impairment across all measures at all follow-up time points. p Predicted outcome above and beyond previously identified predictors, including diagnostic comorbidity at baseline. Post hoc analyses showed that p predicted long-term anxiety outcome, but not acute treatment outcome, suggesting that p may be uniquely associated with long-term outcome.

CONCLUSION

Children and adolescents with anxiety disorders who present with a liability toward broad mental health problems may be at a higher risk for poor long-term outcome across mental health and functional domains. Efforts to assess and to address this broad liability may enhance long-term outcome.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

A Family Socialization Model of Transdiagnostic Risk for Psychopathology in Preschool Children

This longitudinal study examined the presence of general (P) and specific internalizing (INT) and externalizing (EXT) psychopathology factors in a community sample of preschool children. We assessed child and contextual correlates of P, INT, and EXT, and tested a model connecting socioeconomic risk to these factors through family socialization processes and child cognitive abilities. Participants were 501 children recruited at birth and followed up at 18 months and 3 years. Child and family functioning were measured using parental reports, observation, and standardized assessments. Both mothers and their partners reported on children's mental health, permitting the estimation of a trifactor model of psychopathology that captured caregivers' shared and unique perspectives with respect to P, INT, and EXT. Results revealed several transdiagnostic correlates of the common-perspective P factor, including family income, maternal education, maternal depression, and maternal responsiveness, as well as marginal associations with sibling negativity and children's language and theory of mind abilities. Several shared and unique correlates of INT and EXT were also observed. Structural equation modelling revealed that the effects of family income and maternal education on P operated indirectly through maternal responsiveness, while the effects of maternal education on INT and EXT operated through maternal reflective capacity, albeit in opposite directions. Together, these results suggest that the effects of socioeconomic disadvantage on general psychopathology are organized in a temporal cascade from distal to proximal risk.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.

Hierarchical models of psychopathology: empirical support, implications, and remaining issues

There is an ongoing revolution in psychology and psychiatry that will likely change how we conceptualize, study and treat psychological problems.- Many theorists now support viewing psychopathology as consisting of continuous dimensions rather than discrete diagnostic categories. Indeed, recent papers have proposed comprehensive taxonomies of psychopathology dimensions to replace the DSM and ICD taxonomies of categories. The proposed dimensional taxonomies, which portray psychopathology as hierarchically organized correlated dimensions, are now well supported at phenotypic levels. Multiple studies show that both a general factor of psychopathology at the top of the hierarchy and specific factors at lower levels predict different functional outcomes. Our analyses of data on a large representative sample of child and adolescent twins suggested the causal hypothesis that phenotypic correlations among dimensions of psychopathology are the result of many familial influences being pleiotropic. That is, most genetic variants and shared environmental factors are hypothesized to non-specifically influence risk for multiple rather than individual dimensions of psychopathology. In contrast, person-specific experiences tend to be related to individual dimensions. This hierarchical causal hypothesis has been supported by both large-scale family and molecular genetic studies. Current research focuses on three issues. First, the field has not settled on a preferred statistical model for studying the hierarchy of causes and phenotypes. Second, in spite of encouraging progress, the neurobiological correlates of the hierarchy of dimensions of psychopathology are only partially described. Third, although there are potentially important clinical implications of the hierarchical model, insufficient research has been conducted to date to rec-ommend evidence-based clinical practices.

Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach

Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.

The Structure of Psychopathology in a Sample of Clinically Referred, Emotionally Dysregulated Early Adolescents

This investigation answers and amplifies calls to model the transdiagnostic structure of psychopathology in clinical samples of early adolescents and using stringent psychometric criteria. In 162 clinically referred, clinically evaluated 11-13-year-olds, we compared a correlated two-factor model, containing latent internalizing and externalizing factors, to a bifactor model, which added a transdiagnostic general factor. We also evaluated the bifactor model psychometrically, including criterion validity with broad indicators of psychosocial functioning. In doing so, we compared alternative approaches to defining and interpreting criterion validity: a recently proposed incremental definition based on amounts of variance in criterion factors explained, and the more typical definition based on the presence of conceptually meaningful relationships. While traditional fit statistics favored the bifactor model as expected, psychometric analyses added important nuance. Despite moderate reliability, the general factor was not fully transdiagnostic (i.e., was not informed by several externalizing scores), and was partially redundant with internalizing scores. Approaches to criterion validity yielded opposing results. Compared to the correlated two-factor model, the bifactor model redistributed, without incrementally increasing, the total variance explained in criterion indicators of psychosocial functioning. Yet, the bifactor model did improve the precision of clinically important relationships to psychosocial functioning, raising questions about meaningful tests of bifactor psychopathology models.

White Matter Microstructure and the General Psychopathology Factor in Children

OBJECTIVE

Co-occurrence of behavioral and emotional problems in childhood is widespread, and previous studies have suggested that this reflects vulnerability to experience a range of psychiatric problems, often termed a general psychopathology factor. However, the neurobiological substrate of this general factor is not well understood. We tested the hypothesis that lower overall white matter microstructure is associated with higher levels of the general psychopathology factor in children and less with specific factors.

METHOD

Global white matter microstructure at age 10 years was related to general and specific psychopathology factors. These factors were estimated using a latent bifactor model with multiple informants and instruments between ages 6 and 10 years in 3,030 children from the population-based birth cohort Generation R. The association of global white matter microstructure and the psychopathology factors was examined with a structural equation model adjusted for sex, age at scan, age at psychopathology assessment, parental education/income, and genetic ancestry.

RESULTS

A 1-SD increase of the global white matter factor was associated with a β = -0.07SD (standard error [SE] = 0.02, p < .01) decrease in general psychopathology. In contrast, a 1-SD increase of white matter microstructure predicted an increase of β = +0.07 SD (SE = 0.03, p < .01) specific externalizing factor levels. No association was found with the specific internalizing and specific attention factor.

CONCLUSION

The results suggest that general psychopathology in childhood is related to white matter structure across the brain and not only to specific tracts. Taking into account general psychopathology may also help reveal neurobiological mechanisms behind specific symptoms that are otherwise obscured by comorbidity.

Comorbidity in borderline personality: understanding dynamics in development

Borderline personality disorder is marked by high levels of comorbidity in both adolescent and adult populations. However, the mechanisms involved in the development of comorbidity in BPD remain unclear. To address this issue, the current paper proposes the use of dynamic mutualism theory as a valuable and underexplored framework for investigating comorbidity in BPD from a developmental perspective. Specifically, we discuss how predictions of dynamic mutualism can be extended to better understand the onset, maintenance, and interplay of BPD symptoms with other forms of psychopathology over time. Moreover, we suggest that mutualistic interactions among internalizing and externalizing features throughout early development may foster the emergence of BPD symptoms in adolescence and beyond. Next, we discuss methodological approaches for testing mutualism and review indirect evidence that supports the role of mutualistic processes in the emergence and maintenance of BPD and its comorbidities. We conclude with methodological cautions and recommendations for future studies.

Criterion validity and relationships between alternative hierarchical dimensional models of general and specific psychopathology

[Correction Notice: An Erratum for this article was reported in Vol 129(7) of Journal of Abnormal Psychology (see record 2020-72912-001). In the article (http://dx.doi.org/10.1037/abn0000601), an acknowledgment is missing from the author note. The missing acknowledgement is included in the erratum.] Psychopathology can be viewed as a hierarchy of correlated dimensions. Many studies have supported this conceptualization, but they have used alternative statistical models with differing interpretations. In bifactor models, every symptom loads on both the general factor and 1 specific factor (e.g., internalizing), which partitions the total explained variance in each symptom between these orthogonal factors. In second-order models, symptoms load on one of several correlated lower-order factors. These lower-order factors load on a second-order general factor, which is defined by the variance shared by the lower-order factors. Thus, the factors in second-order models are not orthogonal. Choosing between these valid statistical models depends on the hypothesis being tested. Because bifactor models define orthogonal phenotypes with distinct sources of variance, they are optimal for studies of shared and unique associations of the dimensions of psychopathology with external variables putatively relevant to etiology and mechanisms. Concerns have been raised, however, about the reliability of the orthogonal specific factors in bifactor models. We evaluated this concern using parent symptom ratings of 9-10 year olds in the ABCD Study. Psychometric indices indicated that all factors in both bifactor and second-order models exhibited at least adequate construct reliability and estimated replicability. The factors defined in bifactor and second-order models were highly to moderately correlated across models, but have different interpretations. All factors in both models demonstrated significant associations with external criterion variables of theoretical and clinical importance, but the interpretation of such associations in second-order models was ambiguous due to shared variance among factors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations Between Resting-State Functional Connectivity and a Hierarchical Dimensional Structure of Psychopathology in Middle Childhood

BACKGROUND

Previous research from the Adolescent Brain Cognitive Development (ABCD) Study delineated and validated a hierarchical 5-factor structure with a general psychopathology (p) factor at the apex and 5 specific factors (internalizing, somatoform, detachment, neurodevelopmental, externalizing) using parent-reported child symptoms. The present study is the first to examine associations between dimensions from a hierarchical structure and resting-state functional connectivity (RSFC) networks.

METHODS

Using 9- to 11-year-old children from the ABCD Study baseline sample, we examined the variance explained by each hierarchical structure level (p-factor, 2-factor, 3-factor, 4-factor, and 5-factor models) in associations with RSFC. Analyses were first conducted in a discovery dataset (n = 3790), and significant associations were examined in a replication dataset (n = 3791).

RESULTS

There were robust associations between the p-factor and lower connectivity within the default mode network, although stronger effects emerged for the neurodevelopmental factor. Neurodevelopmental impairments were also related to variation in RSFC networks associated with attention to internal states and external stimuli. Analyses revealed robust associations between the neurodevelopmental dimension and several RSFC metrics, including within the default mode network, between the default mode network with cingulo-opercular and "Other" (unassigned) networks, and between the dorsal attention network with the Other network.

CONCLUSIONS

The hierarchical structure of psychopathology showed replicable links to RSFC associations in middle childhood. The specific neurodevelopmental dimension showed robust associations with multiple RSFC metrics. These results show the utility of examining associations between intrinsic brain architecture and specific dimensions of psychopathology, revealing associations especially with neurodevelopmental impairments.

Developmental pathways to social anxiety and irritability: The role of the ERN

Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.

The co-occurrence between symptoms of internet gaming disorder and psychiatric disorders in childhood and adolescence: prospective relations or common causes?

BACKGROUND

Internet gaming disorder (IGD) is highlighted as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Some studies indicate that IGD appears comorbid with other psychiatric disorders. We examine concurrent and prospective links between symptoms of IGD and symptoms of common psychiatric disorders in childhood and adolescence to determine whether observed comorbidity is a result of (a) reciprocal relations or (b) common underlying causes.

METHODS

A community sample (n = 702) of Norwegian children completed the Internet Gaming Disorder Interview (IGDI) to assess DSM-5 defined IGD symptoms at ages 10, 12 and 14 years. The Child and Adolescent Psychiatric Assessment (CAPA) assessed symptoms of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) at the same time points.

RESULTS

A Random Intercept Cross-lagged Panel Model (RI-CLPM), which captures pure within-person changes and adjusts for all unmeasured time-invariant factors (e.g., genetics, parent education) revealed no associations between IGD symptoms and psychopathology, except that increased IGD symptoms at ages 10 and 12 predicted decreased symptoms of anxiety two years later.

CONCLUSIONS

No support emerged for concurrent or prospective relations between IGD and psychiatric symptoms, except in one case: increased IGD symptoms forecasted reduction in anxiety symptoms. Observed co-occurrence between IGD symptoms and mental health problems can mainly be attributed to common underlying factors.

An examination of reciprocal associations between substance use and effortful control across adolescence using a bifactor model of externalizing symptoms

Early adolescence is thought to represent a window of vulnerability when exposure to substances is particularly harmful, partly because the neurotoxic effects of adolescent substance use may derail self-regulation development. However, previous studies fail to account for externalizing symptoms, such as aggression and delinquency, that accompany adolescent substance use and may also derail the development of self-regulation. The current study aims to clarify whether the neurotoxic effects of adolescent substance use are associated with deficits in effortful control (EC) after accounting for externalizing symptoms and to examine reciprocal relationships between EC, externalizing symptoms, and substance use. A longitudinal sample of adolescents (N = 387) was used to estimate bifactor models of externalizing symptoms across five assessments (Mage = 11.6 to 19.9). The broad general externalizing factors were prospectively associated with declines in EC across adolescence and emerging adulthood. However, the narrow substance use specific factors were not prospectively associated with EC. Findings suggest that the broader externalizing context, but not the specific neurotoxic effects of substance use, may hamper self-regulation development. It is critical to account for the hierarchical structure of psychopathology, namely externalizing symptoms, when considering development of EC.

Appropriate Use of Bifactor Analysis in Psychopathology Research: Appreciating Benefits and Limitations

Co-occurrence of psychiatric disorders is well documented. Recent quantitative efforts have moved toward an understanding of this phenomenon, with the general psychopathology or p-factor model emerging as the most prominent characterization. Over the past decade, bifactor model analysis has become increasingly popular as a statistical approach to describe common/shared and unique elements in psychopathology. However, recent work has highlighted potential problems with common approaches to evaluating and interpreting bifactor models. Here, we argue that bifactor models, when properly applied and interpreted, can be useful for answering some important questions in psychology and psychiatry research. We review problems with evaluating bifactor models based on global model fit statistics. We then describe more valid approaches to evaluating bifactor models and highlight 3 types of research questions for which bifactor models are well suited to answer. We also discuss the utility and limits of bifactor applications in genetic and neurobiological research. We close by comparing advantages and disadvantages of bifactor models with other analytic approaches and note that no statistical model is a panacea to rectify limitations of the research design used to gather data.

Global deficits in executive functioning are transdiagnostic mediators between severe childhood neglect and psychopathology in adolescence

BACKGROUND

Children reared in institutions experience profound deprivation that is associated with both heightened levels of psychopathology and deficits in executive functioning (EF). It is unclear whether deficits in EF among institutionally-reared children serve as a vulnerability factor that increases risk for later psychopathology. It is also unclear whether this putative association between EF and psychopathology is transdiagnostic (i.e. cuts across domains of psychopathology), or specific to a given syndrome. Thus, we examined whether global deficits in EF mediate the association between severe childhood neglect and general v. specific psychopathology in adolescence.

METHODS

The sample consisted of 188 children from the Bucharest Early Intervention Project, a longitudinal study examining the brain and behavioral development of children reared in Romanian institutions and a comparison group of never-institutionalized children. EF was assessed at age 8, 12, and 16 using a well-validated measure of neuropsychological functioning. Psychopathology was measured as general (P) and specific internalizing (INT) and externalizing (EXT) factors at age 12 and 16.

RESULTS

Institutionally-reared children had lower global EF and higher general psychopathology (P) at all ages compared to never-institutionalized children. Longitudinal path analysis revealed that the effect of institutionalization on P at age 16 operated indirectly through poorer EF from ages 8 to 12. No indirect effects involving EF were observed for INT or EXT at age 16.

CONCLUSIONS

We conclude that stable, global deficits in EF serve as a cognitive endophenotype that increases transdiagnostic vulnerability to psychopathology in adolescence among those who have experienced profound early neglect.

Children's attentional biases to emotions as sources of variability in their vulnerability to interparental conflict

Little is known about the role children's processing of emotions plays in altering children's vulnerability to interparental conflict. To address this gap, the present study examined whether the mediational cascade involving children's exposure to interparental conflict, their insecure responses to interparental conflict, and their psychological problems varied as a function of children's preexisting biases to attend to angry, fearful, sad, and happy expressions. Participants included 243 children (M age = 4.60 years) and their parents assessed at 3 annual measurement occasions. Moderated-mediation analyses within a cross-lagged autoregressive design indicated that the indirect paths among interparental conflict, emotional insecurity, and psychological problems were significant for children who exhibited greater attentional biases toward angry and fearful emotions. Greater attention to anger and fear specifically moderated the first link in the mediational path. Interparental conflict was a significantly stronger predictor of emotional insecurity for children who attended to angry and fearful cues longer. Consistent with environmental sensitivity theories, children with attentional biases to angry and fearful emotions exhibited disproportionately higher levels of emotional insecurity following exposure to heightened interparental conflict but also lower levels of emotional insecurity after experiencing minimal interparental conflict. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis-related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

The structure of psychopathology and association with poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem in a population sample of adolescents

There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.

Executive Function and Psychopathology: A Neurodevelopmental Perspective

Executive function (EF) skills are neurocognitive skills that support the reflective, top-down coordination and control of other brain functions, and there is neural and behavioral evidence for a continuum from more "cool" EF skills activated in emotionally neutral contexts to more "hot" EF skills needed for the reversal of motivationally significant tendencies. Difficulties in EF are transdiagnostic indicators of atypical development. A neurodevelopmental model traces the pathway from adverse childhood experiences and stress to disruption of the development of neural systems supporting reflection and EF skills to an increased risk for general features of psychopathology. Research indicates that EF skills can be cultivated through scaffolded training and are a promising target for therapeutic and preventive intervention. Intervention efficacy can be enhanced by mitigating disruptive bottom-up influences such as stress, training both hot and cool EF skills, and adding a reflective, metacognitive component to promote far transfer of trained skills.

The General Factor of Psychopathology

An important advance in understanding and defining mental disorders has been the development of empirical approaches to mapping dimensions of dysfunction and their interrelatedness. Such empirical approaches have consistently observed intercorrelations among the many forms of psychopathology, leading to the identification of a general factor of psychopathology (the p factor). In this article, we review empirical support for p, including evidence for the stability and criterion validity of p. Further, we discuss the strong relationship between p and both the general factor of personality and the general factor of personality disorder, substantive interpretations of p, and the potential clinical utility of p. We posit that proposed substantive interpretations of p do not explain the full range of symptomatology typically included in p. The most plausible explanation is that p represents an index of impairment that has the potential to inform the duration and intensity of a client's mental health treatment.

The wide-ranging life outcome correlates of a general psychopathology factor in adolescent psychopathology

BACKGROUND

The structure of psychopathology has been much debated within the research literature. This study extends previous work by providing comparisons of the links between psychopathology and several life outcomes (temperamental, economic, social, psychological and health) using a three-correlated-factors model, a bifactor model, a revised-bifactor model and a higher-order model.

METHODS

Data from a sample of Dutch adolescents were used (n = 2 230), and psychopathology factors were modelled using self-reported and parent-reported longitudinal data from youth across four assessments during adolescence, from ages 11 to 19. Outcome variables were assessed at age 22 using adolescent-reports and parent-reports and more objective measures (e.g. body mass index).

RESULTS

While no measurement model was clearly superior, we found modest associations between the psychopathology factors and life outcomes. Importantly, after taking into account a general factor, the associations with life outcomes decreased for the residual parts of thought problems (across all domains) and internalizing problems (for temperamental and psychological outcomes), but not for externalizing problems, compared with the traditional three-correlated-factors model. Patterns were similar for adolescent-reported and parent-reported data.

CONCLUSIONS

Findings suggest that a general factor is related to psychopathology and life outcomes in a meaningful way. Results are discussed in terms of individual differences in propensity to psychopathology and more broadly in light of recent developments concerning the structure of psychopathology. © 2019 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

General Psychopathology and Dysregulation Profile in a Longitudinal Community Sample: Stability, Antecedents and Outcomes

The general factor of psychopathology (GP, or p factor) and the Dysregulation Profile (DP) are two conceptually similar, but independently developed approaches to understand psychopathology. GP and DP models and their stability, antecedents and outcomes are studied in a longitudinal sample of 1073 children (49.8% female). GP and DP models were estimated at ages 8 and 14 years using the parent-reported Child Behavior Checklist (CBCL) and Youth Self Report (YSR). Early childhood antecedents and adolescent outcomes were derived using a multi-method multi-informant approach. Results showed that the general GP and DP had similar key symptoms and were similarly related to early-childhood antecedents (e.g., lower effortful control, higher maternal depression) and adolescent outcomes (e.g., reduced academic functioning, poorer mental health). This study demonstrates that GP and DP are highly similar constructs in middle childhood and adolescence, both describing a general vulnerability for psychopathology with (emotional) dysregulation at its core. Scientific integration of these approaches could lead to a better understanding of the structure, antecedents and outcomes of psychopathology.

Specificity of psychopathology across levels of severity: a transdiagnostic network analysis

A prominent hypothesis within the field of psychiatry is that the manifestation of psychopathology changes from non-specific to specific as illness severity increases. Using a transdiagnostic network approach, we investigated this hypothesis in four independent groups with increasing psychopathology severity. We investigated whether symptom domains became more interrelated and formed more clusters as illness severity increased, using empirical tests for two network characteristics: global network strength and modularity-based community detection. Four severity groups, ranging from subthreshold psychopathology to having received a diagnosis and treatment, were derived with a standardized diagnostic interview conducted at age 18.5 (n = 1933; TRAILS cohort). Symptom domains were assessed using the Adult Self Report (ASR). Pairwise comparisons of the symptom networks across groups showed no difference in global network strength between severity groups. Similar number and type of communities detected in the four groups exceeded the more minor differences across groups. Common clusters consisted of domains associated with attention deficit hyperactivity disorder (ADHD) and combined depression and anxiety domains. Based on the strength of symptom domain associations and symptom clustering using a network approach, we found no support for the hypothesis that the manifestation of psychopathology along the severity continuum changes from non-specific to specific.

Delineating and validating higher-order dimensions of psychopathology in the Adolescent Brain Cognitive Development (ABCD) study

Hierarchical dimensional systems of psychopathology promise more informative descriptions for understanding risk and predicting outcome than traditional diagnostic systems, but it is unclear how many major dimensions they should include. We delineated the hierarchy of childhood and adult psychopathology and validated it against clinically relevant measures. Participants were 9987 9- and 10-year-old children and their parents from the Adolescent Brain Cognitive Development (ABCD) study. Factor analyses of items from the Child Behavior Checklist and Adult Self-Report were run to delineate hierarchies of dimensions. We examined the familial aggregation of the psychopathology dimensions, and the ability of different factor solutions to account for risk factors, real-world functioning, cognitive functioning, and physical and mental health service utilization. A hierarchical structure with a general psychopathology ('p') factor at the apex and five specific factors (internalizing, somatoform, detachment, neurodevelopmental, and externalizing) emerged in children. Five similar dimensions emerged also in the parents. Child and parent p-factors correlated highly (r = 0.61, p < 0.001), and smaller but significant correlations emerged for convergent dimensions between parents and children after controlling for p-factors (r = 0.09-0.21, p < 0.001). A model with child p-factor alone explained mental health service utilization (R² = 0.23, p < 0.001), but up to five dimensions provided incremental validity to account for developmental risk and current functioning in children (R² = 0.03-0.19, p < 0.001). In this first investigation comprehensively mapping the psychopathology hierarchy in children and adults, we delineated a hierarchy of higher-order dimensions associated with a range of clinically relevant validators. These findings hold important implications for psychiatric nosology and future research in this sample.

In search of disorders: internalizing symptom networks in a large clinical sample

BACKGROUND

The co-occurrence of internalizing disorders is a common form of psychiatric comorbidity, raising questions about the boundaries between these diagnostic categories. We employ network psychometrics in order to: (a) determine whether internalizing symptoms cluster in a manner reflecting DSM diagnostic criteria, (b) gauge how distinct these diagnostic clusters are and (c) examine whether this network structure changes from childhood to early and then late adolescence.

METHOD

Symptom-level data were obtained for service users in publicly funded mental health services in England between 2011 and 2015 (N = 37,162). A symptom network (i.e. Gaussian graphical model) was estimated, and a community detection algorithm was used to explore the clustering of symptoms.

RESULTS

The estimated network was densely connected and characterized by a multitude of weak associations between symptoms. Six communities of symptoms were identified; however, they were weakly demarcated. Two of these communities corresponded to social phobia and panic disorder, and four did not clearly correspond with DSM diagnostic categories. The network structure was largely consistent by sex and across three age groups (8-11, 12-14 and 15-18 years). Symptom connectivity in the two older age groups was significantly greater compared to the youngest group and there were differences in centrality across the age groups, highlighting the age-specific relevance of certain symptoms.

CONCLUSIONS

These findings clearly demonstrate the interconnected nature of internalizing symptoms, challenging the view that such pathology takes the form of distinct disorders.

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system-the Hierarchical Taxonomy of Psychopathology (HiTOP)-that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.

Editorial: The psychopathology p factor: will it revolutionise the science and practice of child and adolescent psychiatry?

The psychopathology p factor has emerged from a series of strong empirical studies, largely in the adult psychiatry literature. Here, some of the recent findings relating to the p factor in children and adolescents are considered and the implications for child and adolescent psychiatry are discussed. Is it essential to covary for 'p' when we study specific domains of psychopathology? Do neurodevelopmental conditions make up part of the psychopathology p factor? How do we treat the 'p factor' in clinics? This editorial considers some of the contributions from this issue of Journal of Child Psychology and Psychiatry together with the wider literature that speak to these issues.

The General Psychopathology Factor: Structural Stability and Generalizability to Within-Individual Changes

Objectives: Although cross-sectional investigations have found a bifactor structure of psychiatric comorbidity that includes a general psychopathology factor plus more specific factors, prospective evidence supporting the bifactor structure is still limited. We evaluated the structural stability (i.e., longitudinal invariance) of the bifactor model in comparison to an alternative structure, a correlated factors model without a general psychopathology factor. We also investigated the models' generalizability to change processes in psychopathology. Methods: The analyses were conducted on 10-year follow-up data from 5,001 respondents in the US National Comorbidity Survey. Invariance was evaluated through a series of nested invariance tests using confirmatory factor analysis, and the models' generalizability to change processes was investigated using change scores of disorder status. Results: The bifactor model and the correlated factors model exhibited an equal degree of strong structural stability over time. Only the bifactor model satisfactorily characterized the structure of temporal changes in psychopathology. Conclusions: The bifactor structure with a general psychopathology factor is stable over time and describes temporal changes in psychopathology. The findings support the notion that the general psychopathology factor describes a transdiagnostic etiology and may therefore provide a useful target for intervention and treatment.